Active NPI
Jacob Davis
- Health Maintenance Organization
- Baton Rouge, LA
National Provider Identifier
1932672979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Maintenance Organization
- License
- 5559
- Practice address
- 606 Colonial Dr Ste B
Baton Rouge, LA 70806-6535 - Phone
- (225) 406-7670
- NPI assigned
- Jan 2, 2019
- Last updated
- Jan 2, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Maintenance Organization | 302R00000X | 5559 | LA | Primary |
Addresses
Primary practice location
606 Colonial Dr Ste B
Baton Rouge, LA 70806-6535
Mailing address
606 Colonial Dr Ste B
Baton Rouge, LA 70806-6535
Phone (225) 406-7670
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 601008607 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5559 | LA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546387200000",
"number": "1932672979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "606 COLONIAL DR STE B",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708066535",
"telephone_number": "225-406-7670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "606 COLONIAL DR STE B",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708066535",
"telephone_number": "225-406-7670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JACOB",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-01-02",
"last_updated": "2019-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "302R00000X",
"taxonomy_group": "",
"desc": "Health Maintenance Organization",
"state": "LA",
"license": "5559",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "601008607",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baton Rouge, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.